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DocuSign Envelope ID: C8479571-74E8-4DCC-8F07-F71 D3249C902
<br />'Arm
<br />9
<br />Request for Taxpayer
<br />Give Farr„ to the
<br />Form to er
<br />Identification Number and Certification
<br />requester. Do not
<br />(Rev. October heTr
<br />De mil Rev rue Treasury
<br />Internal Revon'enue service
<br />► Go to www,lrs. ov/FormW9 for Instructions and the latest information.
<br />9
<br />Send to the IRS.
<br />1 Name (as shown on your Income tax return). Name Is required on this line; do not leave this line blank.
<br />2 Business nameldisregamed entity name, If different from above
<br />m
<br />3 Check appropriate box for federal tax classification of the person whose name Is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
<br />certain entitles, not Individuate; sea
<br />following seven boxes,
<br />Instfuctlons on page 3):
<br />n
<br />a
<br />❑ Indviduat/sole proprietor or ❑ C Corporation El Corporation El Partnership ElTmst/estats
<br />ai o
<br />single -member LLC Exempt payee code (if any)
<br />❑ Limited llablllty, company. Enter the tax classification(C=C corporation. S=S coryorell(n, P=Partnership)►
<br />`p
<br />Note: Check the appropriate box In the line obove for the tax cieeeiflat lion of the eingle-member owner. Do not check Exemption from FATCA reporting
<br />19
<br />LLC If the LLC Is clossirled as a single -member LLC that Is disregarded from the owner unless the owner of the LLC Is code (if any)
<br />Ic
<br />another LLC that le not disregarded from the owner for U.S. federal tax purposes, Otherwise, a single -member LLC that
<br />n-
<br />Is disregarded from the owner should check the appropriate box for the tax classification of Its owner.
<br />❑ Other(89el ft lona)► (Appparto aow,afa meAxeNetl outside ko e8.)
<br />N
<br />a Address (number, street and apt. or suite no.) Sea instructions. Requester'sl(sdrms 'mladdress (optional)
<br />ro
<br />e City, state, end ZIP code
<br />r List account number(A) hem (optional)
<br />ffM
<br />Taxpayer Identif cation Number(TIN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avold
<br />Saslal
<br />aecurky
<br />number
<br />backup withholding, For Individuals, this Is generally your social security number (SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Pan I, later. For other
<br />W
<br />__ .,,e_- a ,...,..�,. e...w,..,e. umnaMnenn numlrar frim If vnu do nrd have a number. see How to oet a
<br />anE , ,, ,a a..... ,,,,,v,.x... ......................._...__. ,_.. ,... , -- --
<br />TIN, later. -
<br />Note: If the account Is In more than one name, seethe Instructions for line 1. Also see What Name and
<br />Number To Give the Requesterfor guidelines on whose number to enter.
<br />1. The number shown on this form Is my correct taxpayer Identl8callon number (or I am waiting for a number to be Issued to me); and
<br />2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Intemal Revenue
<br />Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
<br />no longer subject to backup withholding; and
<br />3, 1 am a U.S. citizen or other U.S. person (defined below); and
<br />4, The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting Is correct.
<br />Certification Instructions. You must cross out Item 2 above If you have been notified by the IRS that you are currently subjeelto backup withholding because
<br />you have failed to report all interest and dividends on yourtax return. For real estate transactions, Item 2 does not apply, For mortgage Interest paid,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments
<br />other lhan Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
<br />Sign signatureof
<br />Here I U.S. person► _ _ Date ►
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Future developments. For the latest Information about developments
<br />related to Form W-9 and Its Instructions, such as legislation enacted
<br />after they were published, go to www,lrs.gov/Form I0-
<br />Purpose of Form
<br />An Individual or entity (Form W-9 requester) who is required to file an
<br />Information return with the IRS must obtain your correct taxpayer
<br />Identification number (TIN) which may be your social security number
<br />ISSN), Individual taxpayer Identification number (ITIN), adoption
<br />taxpayer Identification number (ATIN), or employer Identification number
<br />(EIN), to report on an Information return the amount paid to you, or other
<br />amount reportable on an Information return. Examples of Information
<br />returns Include, but are not limited to, the fallowing.
<br />• Form 1099-INT (Interest earned or paid)
<br />• Form 1099-DIV (dividends, Including those from stocks or mutual
<br />funds)
<br />• Form 1099-MISO (vadoustypes of Income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />• Form 1099-5 (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage Interest),1008-E (student loan Interest),
<br />1098-T (tulgon)
<br />• Form 1090-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a U.S. person (Including a resident
<br />alien), to provide your correct TIN.
<br />ff you do not return Form W-9 to the requesterwith a TIN, you might
<br />be subject to backup withholding, See What Is backup withholding,
<br />later.
<br />Cat. No. 10231X Form W9 (Rev. 10-2e111)
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